Provider Demographics
NPI:1528548401
Name:STEPHANIE PELAYO, PSYD & CO., PSYCHOLOGICAL CORP.
Entity Type:Organization
Organization Name:STEPHANIE PELAYO, PSYD & CO., PSYCHOLOGICAL CORP.
Other - Org Name:SOULWELL FAMILY GUIDANCE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PELAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-929-2300
Mailing Address - Street 1:4330 GOLDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4651
Mailing Address - Country:US
Mailing Address - Phone:909-313-9098
Mailing Address - Fax:909-393-3396
Practice Address - Street 1:14772 PIPELINE AVE STE D
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6027
Practice Address - Country:US
Practice Address - Phone:909-313-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19697261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAQ772ZOtherMCARE